Urology Coding Alert

Question: One of our urologists saw a patient in the morning for a urethral stricture, and then that afternoon the patient returned to see a different doctor, within a practice of 11 urology doctors, for ED that was not related to the stricture. Can we bill for both established patient visits?


Minnesota Subscriber


Answer: This is always a difficult problem for coders. In general, most carriers will not reimburse for two office visits on the same day, especially if they are for the same condition or problem, and the patient is seeing two physicians from the same practice. In your case, however, there were different diagnoses, although the second problem (erectile dysfunction, ED) was not an emergency visit.

Carriers will likely question why the physicians could not see the patient for both problems at the same office encounter. Most likely because you have a large group, one urologist of the group specifically interested in ED or having had special training in ED may see all the patients with ED, and this patient wished to follow up his ED problem with that physician.

What to do: Report both E/M services using the appropriate level of new or established patient code. To be paid for both visits, you'll likely need to submit an explanation of what occurred and why you billed for two visits on the same day. Include your medical record documentation of the two visits.

Carriers may differ in their requirements for reporting two visits on the same day for two different diagnoses, and some of the coding may seem to be controversial when compared with standard coding rules:

CPT (AMA) requires the following (assuming levels of service):

• First visit: 99213
• Second visit: 99212-59

Medicare TrailBlazer requires the following:

• First visit: 99213
• Second visit: 99212-76

Vermont Medicaid requires the following:

• First visit: 99213
• Second visit: 99212-25

Best bet: Check with the individual carriers on how they want you to report multiple same-day office E/M visits.

Tip: Remember to always report two hospital visits on the same day with one CPT code, possibly increasing the level to reflect any increased work performed in providing these two services. You may keep this same coding principle in mind and follow it when you're also reporting two office visits on the same day.

When dealing with more than one diagnosis in the office setting, often the increased medical decision-making for the two different diagnoses may lead to the documentation of a higher final level of care for the combined two visits.